Provider Demographics
NPI:1467903708
Name:SPORTMED INTERNATIONAL, LLC
Entity Type:Organization
Organization Name:SPORTMED INTERNATIONAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:NAZARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-534-3062
Mailing Address - Street 1:U12 CALLE 10
Mailing Address - Street 2:ALTURAS DE FLAMBOYAN
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-8052
Mailing Address - Country:US
Mailing Address - Phone:787-534-3062
Mailing Address - Fax:888-762-2577
Practice Address - Street 1:S3-11 CARR 21
Practice Address - Street 2:URB LAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3345
Practice Address - Country:US
Practice Address - Phone:787-534-3062
Practice Address - Fax:888-762-2577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies